A diverse array of therapeutic options exist for the treatment of alcohol and substance use disorders.
One option is dialectical behavior therapy (DBT), a type of therapy developed by psychologist Marsha Linehan in the 1980s. Linehan initially devised DBT to help treat people with borderline personality disorder (BPD), but over the past three decades, therapists have adapted and used DBT to effectively treat a number of behavioral and emotional disorders, including alcohol use disorder (alcoholism) and substance use disorder (drug addiction).
This article offers a basic definition of DBT and explains how it benefits people in treatment, detox and recovery.
Understanding Dialectical Behavior Therapy
Behavioral therapies involve one-on-one and/or group counseling that focuses on teaching people how to identify and correct problems in their thoughts and actions. DBT is a specific subtype of cognitive behavioral therapy (CBT).
To learn about CBT and addiction treatment, click here.
During CBT, a trained therapist helps a person in recovery learn how their specific thoughts influence their emotions and behavior. By identifying and changing negative thought patterns, a person in recovery can change their non-productive, life-interrupting feelings and actions.
DBT takes this principle – changes in thought lead to changes in behavior – and adds specialized components that focus on emotional regulation, stress tolerance, and mindfulness. The core idea behind DBT lies in the word dialectical, which has two meanings that are relevant to understanding how DBT works.
- Of or relating to the logical discussion of ideas and opinions
- Concerned with or acting through opposing forces.
During DBT, therapists engage in an open and honest dialogue with individuals in treatment – that’s how DBT relates to the first part of this definition. The primary distinguishing feature of DBT, however, lies in the second definition. DBT therapists help people in recovery understand that two opposing ideas or concepts can coexist and that this interplay of fundamental opposites is a defining aspect of reality. Dynamic opposites are a feature of reality – not a bug.
The dialectic at the core of the disordered use of substances is the oppositional relationship of acceptance and change. A person in recovery must accept the reality that they have a behavioral disorder while simultaneously realizing they have the power to change that reality by taking steps to manage their behavioral disorder.
What Are the Benefits Of DBT?
The benefits of DBT are best explained by understanding the core skills DBT therapists teach patients in recovery. These include:
People with alcohol and substance use disorder often experience erratic behavior and extreme mood swings. DBT therapists use mindfulness to help people in recovery identify their emotional states without judging them. Once they accept their internal reality as-is, they can then step back and learn to process their disruptive emotions or patterns of thought in ways that help them, rather than hurt them.
Painful emotions related to past trauma or present challenges often play a large role in addiction. People turn to alcohol and drugs to soothe their emotions and live with difficult circumstances. A DBT therapist teaches people in recovery the skills needed to accept their emotional states and life circumstances without judgment – as mentioned above – then teaches them specific practical skills to handle stressful situations without resorting to non-productive behaviors, such as drinking or using drugs.
DBT teaches real skills that people in recovery can apply immediately – even before they leave treatment. With practice, over time, the emotional regulation and distress tolerance skills learned during DBT becomes new default coping skills. People in treatment learn they have the power to navigate life without using alcohol and drugs. This improves their feelings of self-worth and ultimately improves their confidence, self-image, and self-esteem.
Setting and Achieving Goals.
Active addiction can cause an individual to give up on both short-term and long-term goals. Improved emotional regulation combined with enhanced distress tolerance and elevated self-esteem can lead a person in recovery back to goals they may have forgotten, or lead them to a place where they can create new goals – and use their DBT skills every day to achieve those goals.
Addiction often impairs the ability to maintain healthy and positive personal relationships. It can damage friendships, romances, workplace dynamics, and family interactions. This is not always because the person in active addiction engages in problematic behavior while they’re under the influence of intoxicants. It’s often because they lose the ability to create and maintain healthy boundaries. They forget how advocate for their basic emotional and psychological needs. They lose the ability to communicate effectively in difficult situations.
DBT skills give people in treatment the tools they need to do all of the above: create positive boundaries, seek and find emotional and psychological safety, and discuss their emotions without precipitating a crisis. The net effect of these skills on relationships is that they become enriching and fulfilling – or they have the potential to, when DBT skills are applied appropriately
The full suite of DBT skills enables an individual in recovery from alcohol or substance use disorder to create sustainable behavioral change. Once they begin to create the change they want to see in their lives, DBT skills give them the ability to review and revise their behavior as needed. This dynamic element is critical. As people grow in recovery, they change. As they change, they need the skills to create new coping skills that match their development. DBT creates that template, which evidence shows is durable, adaptable, and capable of supporting both small and large behavioral changes over time.
Treatment Helps You Take Control of Your Life
If you’re seeking treatment for an alcohol or substance use disorder, look for one that offers elements of DBT, like mindfulness. That’s not the only thing to look for, though. The most effective treatment centers use an integrated, holistic approach to treatment. DBT is one piece of the puzzle. It’s important, but it’s not the be-all, end-all therapy that solves everything. That doesn’t exist.
At treatment centers that use up-to-date, evidence-based therapeutic practices, individual counseling approaches like DBT are included alongside other treatment approaches, such as:
- Group therapy
- Family therapy
- Experiential therapy
- Dual diagnosis treatment
- Cognitive behavioral therapy
Recovery is a lifelong journey that you do not have to take on your own. Compassionate, evidence-based treatment provided by caring, experienced practitioners can help you change your life for the better. Inpatient and other treatment programs can give you the practical tools you need to learn, grow, and thrive. The life you create in recovery is a life you live on your own terms, free from the painful cycles of alcohol and drug addiction.